Background Knowledge

Africa is a continent of 53 countries with estimated population of 812,138,473. Being the oldest inhabited place on Earth, it is not surprising that Africa is the cradle of neurology. Egyptians were the first to describe the brain. They recognized stroke, migraine, seizures, dementia, tetanus, Bell palsy, and the squeal of head injuries and spinal transection. As long as 5000 years ago, there were Egyptian physicians who specialized in the care of head diseases and can, therefore, be considered the precursors of today’s neurologists. Similarly, the Yorubas of southwestern Nigeria had native physicians who described several classic neurologic diseases; who practiced pharmacotherapeutic therapy based, in part, on empirical phenomena; and who were excellent psychotherapists.

The neurologist-population ratio in African countries varies from 1 per 162 885 persons to none in 11 countries, compared with 1 per 29 200 persons in the United States. There are few African publications in high-impact international journals of neurology. Africa faces a heavy burden of communicable diseases and increasing non-communicable diseases, with few workers, poor equipment, and little research effort to bear it. There is a need for African neuroscientists to discover areas of research unique to the continent in order to advance the frontiers of knowledge for all neurologists.

Concern

A survey on neurologic sciences was prepared in collaboration of Pan African Association of Neurologic Sciences, World Federation of Neurology and the World Health Organization (WHO) and sent to representatives of 53 African nations. The nations were divided into four categories according to the number of neurologists per nation. Group A, with more than10 Neurologists per country, included 11 nations, averaging 711,856 population per neurologist. Group B, with 5 to 10 Neurologists per country, included 5 nations, averaging 1,612,039 population per neurologist. Group C; with 1 to 4 Neurologists per country, included 23 nations, averaging 5,099,908 population per neurologist. Group D; included 12 nations with a total population of 25,939,273 that reported having no neurologists. The level of training, presence of local training programs, ancillary equipment, and practice setting options decreased progressively from Group A to Group D.

The main reason for fewer neurologists in Africa is attributed to:

Lack of medical schools that offer neurology programs. The lack of basic neuroscience courses at the medical schools serves as an impediment to effect graduation of neurologists.

The number of specialists in neurology is clearly lower in Africa than in other World Health Organization (WHO) regions. The median number of neurologists per 100,000 populations is extremely low in Africa; 0.03 versus 0.07 in South-East Asia, 0.32 in the Eastern Mediterranean, 0.77 in the Western Pacific, 0.89 in the Americas and 4.84 in Europe. Only 26 neurology residency training centers were documented in Africa compared with 117 in the United States.

There were few or no neurology training programs in developing countries, the very regions of the world where they are needed most, owing to the overwhelming burden of neurologic disorders.

The African Initiatives Committee met with an agreement to increase the training of neurologists in Africa and establish closer contact with relevant medical schools.